Rebound coagulopathy in patients with snakebite presenting with marked initial coagulopathy.

Objective: An estimated 70% of patients with pit viper snakebites require antivenom to treat serious complications such as coagulopathy. Evidence-based guidance is limited for the appropriate administration of Crotalinae Polyvalent Immune Fab (FabAV) and the duration of laboratory follow-up. The objective of our study was to assess the incidence of marked and recurrent envenomation coagulopathy at our trauma center and identify practice patterns that may prevent serious complications.

Substantial improvement in prophylactic antibiotic administration for open fracture patients: results of a performance improvement program.

Objectives: Administration of early and appropriate antibiotic in treating patients with open fractures is an important early factor in preventing infection and optimizing outcomes. The purpose of this study is to evaluate the effects of an orthopaedic trauma performance improvement program directed at early antibiotic administration for open fracture patients at our trauma center.

Design: Retrospective comparative cohort study of patients treated for an open fracture by before and after implementation of our performance improvement program specifically designed to address early open fracture care.

Measures of clinical outcome before, during, and after implementation of a comprehensive geriatric hip fracture program: is there a learning curve?

Objectives: To evaluate the effects of implementing a multidisciplinary geriatric hip fracture program on clinical outcome measures at our institution.

Design: Retrospective comparative cohort study of consecutive patients treated before, during, and after implementation of this program, including patient data from electronic medical records and state death records.

Setting: Single metropolitan level 2 regional trauma center and community hospital.

The big chill: accidental hypothermia.

A potential cause of such emergent issues as cardiac arrhythmias, hypotension, and fluid and electrolyte shifts, accidental hypothermia can be deadly, is common among trauma patients, and is often difficult to recognize. The author discusses predisposing conditions, the classic presentation, and the effects on normal thermoregulatory processes; explains how to conduct a systems assessment of the hypothermic patient; and describes crucial management strategies.

Cephalomedullary screws as the standard proximal locking screws for nailing femoral shaft fractures.

Objectives: In 2004, we modified our technique for the stabilization of femoral shaft fractures so that all fractures were stabilized using a reconstruction nail with proximal locking screws oriented into the femoral head. The rationale for this was twofold: first, potentially "missed" associated femoral neck fractures would be stabilized. Second, hip fractures that might occur later in life above the intramedullary nail might be avoided.

Anterior-inferior plate fixation of middle-third fractures and nonunions of the clavicle.

Objective: Results of surgical treatment for clavicle injuries using standard approaches have shown relatively high complication rates including loss of fixation, persistent nonunion, implant related problems, and the need for subsequent surgeries are common. The purpose of this study is to evaluate the clinical results of patients treated for clavicle fractures and painful clavicular nonunions with anterior-inferior plating using a 3.5 mm plate.

Effects of surgical errors on small fragment screw fixation.

Objectives: The purpose of this study is to determine the effects of technical errors that occur during the application of small fragment screw fixation and to assess which screw holes can be salvaged.

Intervention: Testing of screw pullout from a bone substitute model on a universal testing instrument (Instron Corp., Canton, MA).

Standard multiplanar fluoroscopy versus a fluoroscopically based navigation system for the percutaneous insertion of iliosacral screws: a cadaver model.

Objectives: To compare the safety and efficiency of standard multiplanar fluoroscopy (StdFluoro) and virtual fluoroscopy (VirtualFluoro) for use in the percutaneous insertion of iliosacral screws.

Design: : Human cadaver study comparing 2 imaging modalities during iliosacral screw insertion; imaging randomized from side to side.

Setting: Bioskills laboratory in a medical school.

Risks to the superior gluteal neurovascular bundle during percutaneous iliosacral screw insertion: an anatomical cadaver study.

Background: Iliosacral screws are a popular technique used to treat complicated injuries of the pelvis. It is well recognized that this technique entails some potentially disabling complications, including damage to vessels and lumbosacral nerves. The recommended insertion site for iliosacral screws into the S1 body lies along the posterior ilium between the greater sciatic notch and the iliac crest.

Early results of the less invasive stabilization system for mechanically unstable fractures of the distal femur (AO/OTA types A2, A3, C2, and C3).

Objectives: Historically, mechanically unstable fractures of the distal femur have been difficult to treat. Problems such as varus collapse, malunion, and nonunion frequently resulted before fixed-angle plates and indirect reduction techniques were popularized. More recently, the Less Invasive Stabilization System, or LISS (Synthes, Paoli, PA), has been designed to combine these 2 approaches with the intended goals of achieving adequate stable fixation and early healing.